1. How did I get HIV? This is a question you’ll ask and get asked exhaustively, and the bottom line is that you likely acquired the HIV virus by coming in contact with the blood or semen of someone who is HIV positive. The most common modes of transmission include unprotected anal or vaginal sex and sharing needles.
2. Is it my fault? No. HIV isn’t some kind of karmic punishment. It is a virus that is communicable and therefore travels between people. Certain types of activities may increase your risks, but we wouldn’t blame a diabetic for their diabetes even though Type 2 diabetes is preventable.
3. Does being HIV-positive mean I also have AIDS? Absolutely not. Confusing HIV for AIDS or using them interchangeably is one of the most frequent mistakes made. In the U.S., the majority of people living with HIV will never develop AIDS, the most advanced stage of HIV disease. AIDS is its own diagnosis and many clinicians prefer “stage three HIV.”
4. Am I going to die? Yes, but probably not anytime soon, and not because of HIV. The truth is, with treatment, people with HIV can live as long and as healthy of a life as those without it. You’re more likely to die from a car accident than from HIV. There can always be complications, just as there are with any chronic condition (like diabetes, for example), and you will be susceptible to the same medical conditions that affect all people. But, as long as you take your meds you’ll likely live a long healthy life with HIV.
5. When should I start treatment? Right now. Ideally you should begin treatment as soon as possible, like the day you get your positive result. Early HIV treatment has been shown to provide long-term advantages. Even if you don’t have symptoms, without treatment your infection can compromise your immune system and make the HIV harder to treat. The sooner you’re on treatment, the sooner you can lower your viral load and even reach undetectable levels where it becomes highly unlikely for you to transmit HIV.
6. What is “Treatment as Prevention?” HIV medication reduces the amount of virus in an HIV-positive person’s blood. The goal is to reduce your “viral load” to a level so low it’s considered “undetectable.” Large-scale studies on both gay and straight couples in which one was HIV-positive and the other was not, have yet to document a single case of transmission while the HIV-positive person is undetectable.
7. Do I have to stop having sex? Absolutely not. In fact, most doctors will encourage you to continue having a healthy sex life. Orgasms can be wonder drugs in themselves: They help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress, loneliness, and depression. But being positive does mean you’ll need to protect your intimate partners.
8. Do I have to disclose? There are a number of reasons to tell your sexual partners that you have HIV. If you’re using a condom, have an undetectable viral load, or know your partner is on PrEP, it may seem irrelevant. However, numerous states have HIV disclosure laws and in some of them it doesn’t even matter whether your partner becomes poz or not. Know what the laws are in your state and protect yourself by disclosing if you need to.
9. Can I still have kids? Yes. Medications can make it so there is less than a 1 percent chance of transmitting HIV between mother and child. A positive father can have his sperm “washed.” You may need to find a specialist who deals with HIV and fertility but you still can conceive. If you’d prefer to adopt or foster parent, there are protections for HIV-positive parents-to-be that ensure you can’t be discriminated against in many areas.
10. Will being HIV-positive affect my ability to undergo gender confirmation surgery or take hormone therapy? No. A study published in 2006 in The Journal of the American Medical Association compared surgery data for both HIV-positive and HIV-negative patients and found that the two groups had the same level of complications. While some HIV medications can impact hormone levels, there are HIV treatments that won’t interfere with your hormone therapy. Work with your doctor to find the right medication regimen to control your HIV, stay on your hormones, and enable you to live in your authentic gender.
11. How do I answer when people ask, ‘Can you get HIV from...’? Start by telling them how it’s not transmitted. The virus cannot survive outside the body, so you cannot get it from toilet seats, band aids, or shared dishes. It’s not transmitted in your saliva, so you can’t get it from kissing or from spit. It’s not transmitted in sweat or urine. You can’t get it from a swimming pool, hot tub, sauna, mosquito or rodent bites, tattoos, or ear/body piercings. Only blood, semen, vaginal fluids, and breast milk carry HIV in quantities concentrated enough to transmit it to another person. One of these fluids from an HIV-positive person must come in contact with mucous membranes or damaged tissue, or be injected into the bloodstream of another person, before HIV transmission can possibly occur.